Association Between Prolonged Immobility and Clinical Complications in Hospitalized Patients: An Integrative Review

Abstract

Introduction: Prolonged immobility is a frequent condition during hospitalization and is associated with important health consequences, particularly among patients with acute illness, advanced age, or reduced functional reserve. Prolonged bed rest may promote loss of muscle strength and mass, physical deconditioning, reduced functional capacity, impaired independence, and the development of clinical complications, including deep vein thrombosis and other consequences related to reduced physical activity. In this context, early identification of immobility and implementation of mobilization and rehabilitation strategies are relevant for preventing complications and promoting functional recovery among hospitalized patients. Objective: To analyze the available evidence on the association between prolonged immobility and complications in hospitalized patients, as well as the role of physical therapy and early mobilization in preventing and mitigating these complications. Methods: This is a descriptive and analytical literature review conducted as an integrative literature review. The following databases were consulted: Virtual Health Library (BVS), Latin American and Caribbean Health Sciences Literature (LILACS), National Library of Medicine (PubMed), SciVerse Scopus (Scopus), and Scientific Electronic Library Online (SciELO). A total of 312 studies were identified, of which 64 duplicate records were removed. After title and abstract screening, 45 articles were assessed in full text and, according to the established eligibility criteria, 12 studies were included in the review. Evidence published between 2008 and 2023 was considered, including observational studies, clinical and experimental studies, systematic reviews, scoping reviews, and meta-analyses addressing hospital immobility, prolonged bed rest, muscle strength loss, deconditioning, vascular complications, early mobilization, and physiotherapy rehabilitation. Results: The studies reviewd suggested that prolonged immobility is associated with important musculoskeletal and functional consequences, including loss of muscle mass and strength, atrophy, reduced physical capacity, and deconditioning. Among hospitalized patients, low mobility was also associated with clinical complications, particularly the relationship between immobility and the occurrence of deep vein thrombosis. Studies conducted in intensive care units indicated that early mobilization and rehabilitation programs may promote functional recovery and reduce the effects of disuse, whereas studies quantifying physical activity during hospitalization demonstrated a predominance of sitting or lying periods and limited time spent standing or walking. Experimental evidence on bed rest further demonstrated significant muscular changes resulting from disuse, although its direct applicability to hospitalized populations should be interpreted with caution. Conclusion: The findings of this review suggest that prolonged immobility is an important factor associated with functional deterioration and the development of clinical complications during hospitalization. Loss of muscle strength and mass, deconditioning, and reduced functional independence are relevant consequences, while immobility may also be associated with vascular complications, particularly among patients with acute medical conditions. Early mobilization, physiotherapy, and individualized rehabilitation strategies may contribute to preserving functional capacity and promoting patient recovery, particularly in intensive care settings. However, heterogeneity among populations, duration of immobility, intervention protocols, and evaluated outcomes, together with the presence of indirect evidence from experimental bed rest studies, limits the generalizability of the findings. Therefore, the results should be interpreted as evidence of a relevant association between prolonged immobility, functional decline, and clinical complications, reinforcing the need for multidisciplinary strategies aimed at preventing and reducing the effects of prolonged bed rest during hospitalization.